My Teacher Has Observed

MY TEACHER HAS OBSERVED

Child Name: Date:

Completed by:

Please check relevant items and make comments: 1. ENGAGEMENT IN ROUTINES 2. PLAY/SOCIAL INTERACTION

MY STRENGTHS: MY STRENGTHS: ___ I anticipate consistent daily routines ___ I explore new objects, toys, and materials ___ I follow the sequence of the routines ___ I Initiate exploration of preferred toys/activities ___ I respond to changes in routines independently ___ I understand classroom expectations ___ I enjoy playing with favorite play objects ___ I respond to familiar activities and situations ___ I engage in interactive play ___ I have favorite activities ___I initiate interaction with familiar adults ___I respond to directions ___ I respond to peer’s social initiation ___ I follow simple directions and complete tasks ___ I have a peer buddy ___ I am cooperative in interactions with adults ___ I take turns with others ___ Other: ___ I Identify emotions of others ___ Other:

MY CHALLENGES: MY CHALLENGES: ___ I require excess attention over time ___ I have limited interest in interacting with play ___ I require individual assistance materials ___ I must be constantly re-directed ___ I require individual assistance with play ___ I have difficulty with transitioning ___ I rarely initiate social interaction ___ I avoid some activities, people, or objects ___ I insist on my turns ___ I become upset or overly stimulated easily ___ I have difficulty understanding social cues ___ I require extra time to respond in unfamiliar ___I have difficulty playing appropriately with peers situations and activities ___ Other: ___ I become easily distracted in particular routines ___ Other: 3. COMMUNICATION SKILLS 4. PROBLEM BEHAVIOR

STRENGTHS: ___ I refuse to follow directions ___ I show my enjoyment using smiles, laughs, or ___ I engage in disruptive behavior during activities verbal language ___ I engage in temper tantrums to get my needs met ___ I understand visual cues or signs ___ I use aggression to obtain or avoid objects or social ___ I understand verbal cues and prompts interaction ___ I express needs using verbal or physical signals and ___I use self-injurious behavior to obtain or avoid objects cues or language or social interaction ___ I use words, phrases, or sentences to ___ I frequently engage in the problem behavior communicate with others ___ I engage in a prolonged periods of problem behavior ___ Other: ___ Other:

MY CHALLENGES: ___ I have difficulty understanding visual or verbal cues and prompts ___ I have difficulty expressing needs ___I have a limited vocabulary for my age ___I have difficulty paying attention when my teacher gives me directions ___ Other: COMMENTS: